经皮椎体成形术治疗胸椎压缩骨折合并肋间神经痛的疗效及可能机制

Effect and possible mechanism of percutaneous vertebroplasty in treatment of intercostal neuralgia caused by thoracic vertebra compression fractures

目的观察经皮椎体成形术治疗骨质疏松性胸椎压缩骨折合并肋间神经痛的疗效,并探讨其可能的机制。方法纳入我院42例骨质疏松性胸椎压缩骨折合并肋间神经痛患者,对其临床资料进行回顾性分析。所有患者均采用经皮椎体成形术治疗,将术前仰卧位疼痛未缓解的患者纳入NR组(7例),将术前仰卧位疼痛缓解的患者纳入R组(35例)。比较2组患者术前及术后1 d、3个月、6个月、12个月疼痛缓解情况,采用疼痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)评估患者背部疼痛、肋间神经痛情况。结果NR组术后1例肋间神经痛缓解,6例未缓解,有效率为14.3%;R组术后34例肋间神经痛缓解良好,1例未缓解,有效率为97.1%,2组比较差异有统计学意义(P=0.003);随访过程中,R组肋间神经痛及背部疼痛缓解良好,与术前比较差异有统计学意义(P<0.05)。结论经皮椎体成形术治疗胸椎压缩骨折伴肋间神经痛,术前仰卧位疼痛不缓解者,术后肋间神经痛多无法缓解,术前仰卧位疼痛缓解者,术后肋间神经痛多能缓解,椎间孔形态改变可能是疼痛相关因素。

Objective To observe the clinical effect of percutaneous vertebroplasty on intercostal neuralgia caused by osteoporotic thoracic compression fractures,and to investigate the possible mechanism.Methods The clinical data of 42 patients with osteoporotic thoracic compression fractures combined with intercostal neuralgia in our hospital were retrospectively analyzed.All these patients were treated with percutaneous verteoplasty,and the patients with unrelieved pain in the supine position before surgery were included in the NR group(7 cases),and the patients with relieved pain in the supine position before surgery were included in the R group(35 cases).Pain relief was compared between the two groups before operation and 1 day,3 months,6 months and 12 months after operation.Visual analogue scale(VAS)score and Oswestry disability index(ODI)were used to evaluate the situation of back pain and intercostal neuralgia.Results In the NR group,1 case showed remission of intercostal neuralgia and the other 6 cases did not,with an effective rate of 14.3%.In the R group,34 cases had good remission of interstitial neuralgia after operation,while 1 case did not,with an effective rate of 97.1%.The difference between the two groups was statistically significant(P=0.003).During the follow-up,intercostal neuralgia and back pain were relieved well in the R Group,and the difference was statistically significant compared with that before surgery(P<0.05).Conclusion In the treatment of intercostal neuralgia caused by thoracic vertebra compression fracture with percutaneous vertebroplasty,postoperative intercostal neuralgia could not be alleviated if the pain was not relieved in the supine position before surgery,while postoperative intercostal neuralgia could be alleviated if the pain was relieved in the supine position before surgery.The morphologic change of intervertebral foramen may be a pain-related factor.